A Comparison of Emotional-Behavioral Problems of Siblings at the Age Range of 3-9 Year Old Children with Autism and Down Syndrome.

Objective
Children's emotional-behavioral problems will have a huge impact on their future. Such problems are more seen in the siblings of children with special needs. The present study aimed to compare emotional-behavioral problems in the healthy siblings of autistic children with the healthy siblings of children with Down syndrome in order to identify such children in Iran.


Materials & Methods
This descriptive study was carried out in Tehran, Iran in 2016 on 174 healthy children aged between 3 and 9 yr old among whom 58 cases had autistic siblings, 58 cases had siblings with Down syndrome, and 58 cases had typically development siblings. The participants were selected using convenience sampling technique. All volunteer parents filled in SDQ Questionnaire. The study results were calculated using independent sample t-test, two-way ANOVA, and Tukey post hoc test by SPSS.


Results
The mean overall score of Strengths and Difficulties Questionnaire was reported as 17.98±6.19 in the autism group, 11.01±6.56 in the Down syndrome group and 4.43±4.34 in the healthy group. There was a significant difference among autism, Down syndrome, and healthy groups. In the group of siblings with Down syndrome, the problems were significantly more in the age range of 3 to 7 yr old (P<0.05). However, no significant difference was observed in the scores of males and females (P>0.05).


Conclusion
Siblings with autism or Down syndrome can have especial psychological effects on healthy children in families in the way that such effect will be more with autistic children. Therefore, formulating beneficial strategies for their parents is used to prevent emotional behavioral problems.


Introduction
The prevalence of emotional-behavioral disorders in children is 1 per 5 cases. Children's emotional-behavioral problems go under the rubric meantime, siblings of children with autism indicate more emotional-behavioral problems including aggression, depression and social isolation compared to siblings of children with Down syndrome (3,11). Another group of studies reported the ineffectiveness or even positive effects of children with autism or Down syndrome on their healthy siblings (12,13). In the studies on siblings of children with Down syndrome, the children had a good self-confidence and acted in dealing with problems in a more mature way (14,15). Although autistic children may increase the risk of autism in other children of families, it would not increase behavioral-emotional problems in the healthy siblings and it should not be considered the cause of adjustment problems with other children (9). In addition, some studies reported positive and negative consequences of having siblings with Down syndrome or autism (11,16). Researchers attribute the reason for the inconsistency on different results and effects of having disabled siblings on people to cultural and social factors, economic differences among families, age and sex of the children and the use of various assessment methods (17,18)  Autism is a type of pervasive developmental disorder associated with a severe injury in social interaction, communicational skills and stereotypical behaviors, interests, and activities (6). Down syndrome is also the most common genetic disorder known as the main cause of intellectual disabilities (7).
In a bulk of studies, having siblings with special needs, especially autism and Down syndrome have been associated with negative effects. Such children experience less welfare than children with healthy siblings (8,9) as well as an increase in emotional-behavioral problems (10). In the

Materials & Methods
This descriptive study was carried out in Tehran, Iran in 2016 on 174 children in three groups with 58 cases consisted of healthy siblings aged between 3 and 9 yr old of children with autism, Down syndrome and healthy children. Tehran was first divided into five districts of East, West, Central, North, and South. Then, of each district, two rehabilitation centers were selected using convenience sampling technique. Then, the subjects were selected among the siblings of children with autism and Down syndrome referred to these 10 centers. However, no qualified one was found from the centers located in the north of the city. In addition, from the same region, 10 elementary boys and girls schools were subscale are summed and converted to standard scores. If a child's score is 52 or less, the child is less likely autistic. If a child's score is between 53 and 84, the probability of autistic child is medium.
If a child's score is 85 or more, the child suffers from severe autism. This test has been normalized for people from 3 to 18 yr old in Iran. According to a study, Gars Scale was simultaneously used to estimate the validity of structure so that the correlation coefficients of two questionnaires was Homogeneity of the groups was evaluated in terms of age and gender taking into account 95% confidence level and 80% power using Chi-square test. In order to access significant difference between the groups in terms of the subscales of SDQ questionnaire, the effect of age was evaluated on the groups using two-way ANOVA. In the case of an interaction in each subscale, the analysis of subgroup including one-way ANOVA and Tukey post hoc test was used. Using independent t-test, two age groups of ( 3-7 yr=1 and 7-9 yr=2) were separately analyzed in each group and analyzed running SPSS Software V.21 (Chicago, IL, USA).

Results
This study was conducted on three 58-member   In the present study, gender had no effect on creating emotional or behavioral disorders. In addition, these disorders were similar for both boys and girls. In this regard, the effect of gender was considered on emotional-behavioral problems neutral (26)

Acknowledgement
This study is related to the project of Nahid All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.